Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany.
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany.
Eur J Nucl Med Mol Imaging. 2018 Dec;45(13):2328-2337. doi: 10.1007/s00259-018-4102-4. Epub 2018 Jul 28.
The purpose of this study was to compare the diagnostic value of a one-step to a two-step staging algorithm utilizing F-FDG PET/MRI in breast cancer patients.
A total of 38 patients (37 females and one male, mean age 57 ± 10 years; range 31-78 years) with newly diagnosed, histopathologically proven breast cancer were prospectively enrolled in this trial. All PET/MRI examinations were assessed for local tumor burden and metastatic spread in two separate reading sessions: (1) One-step algorithm comprising supine whole-body F-FDG PET/MRI, and (2) Two-step algorithm comprising a dedicated prone F-FDG breast PET/MRI and supine whole-body F-FDG PET/MRI.
On a patient based analysis the two-step algorithm correctly identified 37 out of 38 patients with breast carcinoma (97%), while five patients were missed by the one-step F-FDG PET/MRI algorithm (33/38; 87% correct identification). On a lesion-based analysis 56 breast cancer lesions were detected in the two-step algorithm and 44 breast cancer lesions could be correctly identified in the one-step F-FDG PET/MRI (79%), resulting in statistically significant differences between the two algorithms (p = 0.0015). For axillary lymph node evaluation sensitivity, specificity and accuracy was 93%, 95 and 94%, respectively. Furthermore, distant metastases could be detected in seven patients in both algorithms.
The results demonstrate the necessity and superiority of a two-step F-FDG PET/MRI algorithm, comprising dedicated prone breast imaging and supine whole-body imaging, when compared to the one-step algorithm for local and whole-body staging in breast cancer patients.
本研究旨在比较一步法和两步法分期算法利用 F-FDG PET/MRI 在乳腺癌患者中的诊断价值。
本研究共纳入 38 例新诊断的、经组织病理学证实的乳腺癌患者（37 名女性和 1 名男性，平均年龄 57±10 岁；范围 31-78 岁）。所有 PET/MRI 检查均在两次单独的阅读会议中评估局部肿瘤负担和转移扩散：（1）一步法包括仰卧位全身 F-FDG PET/MRI；（2）两步法包括专门的俯卧位 F-FDG 乳腺 PET/MRI 和仰卧位全身 F-FDG PET/MRI。
基于患者的分析，两步法正确识别了 38 例乳腺癌患者中的 37 例（97%），而一步法 F-FDG PET/MRI 算法漏诊了 5 例（33/38；87%的正确识别）。基于病变的分析，两步法共检测到 56 个乳腺癌病变，一步法 F-FDG PET/MRI 可正确识别 44 个乳腺癌病变（79%），两种算法之间存在统计学差异（p=0.0015）。对于腋窝淋巴结评估，敏感性、特异性和准确性分别为 93%、95%和 94%。此外，两种算法均在 7 例患者中检测到远处转移。
结果表明，与一步法相比，两步法（包括专门的俯卧位乳腺成像和仰卧位全身成像）对于乳腺癌患者的局部和全身分期是必要且优越的。
